Thanks to Morris Magnets for helping sponsor the 3 v 3 event
3 v 3 Soccer Tournament
Waiver/Release of Liability and Official Team Roster
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Team Name Age Division Team Contact Person’s Name
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Team Contact Email Team Contact Home Phone Team Contact Cell Phone #
Team Contact Day Phone # Alternate Team Contact Person/Email/Phone Number
PLEASE READ BEFORE SIGNING!
In consideration of being allowed to participate in any way in the Shamrock Charities Soccer Tournament, related events and activities (collectively, the: Event”), the undersigned, for himself/herself, his/her personal representatives, heirs, and next of kin:
1. Acknowledges, appreciates, an agrees that the risk of injury from the activities involved in the Event is significant, including the potential for injury, permanent paralysis and death;
2. Knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume all full responsibility for my participation; and,
3. Willingly agrees to comply with the stated and customary terms and conditions for participation. If however he/she observes any unusual significant hazard during his/her presence or participation, he/she will remove him/herself from participation and bring such to the attention of the nearest official immediately; and
4. Acknowledges, appreciates, and agrees that he/she has read this form and understand that signing this form, he/she is giving up legal rights and remedies on behalf of him/herself and his/her family, estate, heirs, and/or assigns; and
5. HEREBY INDEMNIFIES, RELEASES AND HOLDS HARMLESS SHAMROCK CHARITIES, its affiliates, subsidiaries and parent entities, and their officers, officials, agents and/or employees, directors, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers’ of premises used to conduct the event (“Releasers’”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE; and
6. HAS READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT HE/SHE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUTARILY WITHOUT ANY INDUCEMENT and authorizes on his/her behalf any of the Release’s to obtain any medical care or treatment deemed necessary; and
7. Warrants and represents that he/she (i) is the owner of all rights granted hereunder or has been duly authorized by the owner of such rights to grant same and (ii) is at least eighteen (18) years of age or is the legal parent or guardian of the minor child listed below and is executing this WAIVER/RELEASE OF LIABLITIY/REFUND POLICY/BAD WEATHER POLICY on behalf of such minor child. In the event that the Undersigned is a legal parent or guardian of a minor child who turns the age of 18 during the Event, the acknowledgement and agreement of such child is also required.
8. An informed consent must be signed by parents/guardians or youth athletes acknowledging the risk of head injury. The State of Washington enacted the Lystedt law HB 1824 which addresses head injuries (e.g., concussions). Any player receiving an at risk head blow during the tournament shall not be allowed to play for the duration of the tournament. A referee’s decision to have a player not continue after a head blow shall not be contested by anyone.
SHAMROCK CHARITIES SOCCER REFUND POLICY/BAD WEATHER POLICY There will be no refunds granted for any reason after the registration deadline. This includes, but is not limited to inclement weather, etc. In case of inclement weather, the Event Director reserves the right to reduce the number of scheduled games and/or the time of games and/or postpone or delay game times and/or cancel the Event. Every effort will be made to complete games and the tournament. Entry fees are non-refundable after registration deadlines.
Team Roster/Informed Consent (Lystedt law)
Player’s Full Name (Please Print) Email Address ** Signature (parent or guardian)
**Players may sign if over the age of 18.
Age Division: (please circle) age / gender / group
U10 U11 U12 U13 U14 U15 U16 U17 U18 Male / Female Recreation / Premier
Adult Division: (please circle) if applicable
Over 18 Adult Male / Female
Over 18 Co-Ed
TEAM CONTACT/COACH’S VERIFICATION: This is to certify that this roster does not include any assumed names and that each player conforms to eligibility rule governing Shamrock Charities Soccer.
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COACH/TEAM CONTACT PERSON SIGNATURE DATE PRINT NAME
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EMAIL ADDRESS PHONE <CIRCLE ONE> ( CELL OR OTHER )